Robotic-vs laparoscopic-assisted proctectomy for locally advanced rectal cancer based on propensity score matching: Short-term outcomes at a colorectal center in China

BACKGROUND Reports in the field of robotic surgery for rectal cancer are increasing year by year.However,most of these studies enroll patients at a relatively early stage and have small sample sizes.In fact,studies only on patients with locally advanced rectal cancer(LARC)and with relatively large sample sizes are lacking.AIM To investigate whether the short-term outcomes differed between robotic-assisted proctectomy(RAP)and laparoscopic-assisted proctectomy(LAP)for LARC.METHODS The clinicopathological data of patients with LARC who underwent robotic-or laparoscopic-assisted radical surgery between January 2015 and October 2019 were collected retrospectively.To reduce patient selection bias,we used the clinical baseline characteristics of the two groups of patients as covariates for propensity-score matching(PSM)analysis.Short-term outcomes were compared between the two groups.RESULTS The clinical features were well matched in the PSM cohort.Compared with the LAP group,the RAP group had less intraoperative blood loss,lower volume of pelvic cavity drainage,less time to remove the pelvic drainage tube and urinary catheter,longer distal resection margin and lower rates of conversion(P<0.05).However,the time to recover bowel function,the harvested lymph nodes,the postoperative length of hospital stay,and the rate of unplanned readmission within 30 days postoperatively showed no difference between the two groups(P>0.05).The rates of total complications and all individual complications were similar between the RAP and LAP groups(P>0.05).CONCLUSION This retrospective study indicated that RAP is a safe and feasible method for LARC with better short-term outcomes than LAP,but we have to admit that the clinically significant of part of indicators are relatively small in the practical situation.

Clinical analysis of 2790 children with retinoblastoma: a single-center experience in China

Background In this study,we aimed to analyze the clinical characteristics and prognosis of children with retinoblastoma(RB)in a single center in China with a large sample collection spanning 17 years.Methods The clinical data of 2790 children with RB treated in Beijing Tongren Hospital from 2005 to 2021 were collected,and a retrospective analysis was conducted.Results The median age of the participants was 28.3 months.There were 3624 affected eyes,12.4%of which were in groups A–C,67.1%in groups D–E and 16.2%were not specified.The primary symptom observed in most cases was a white pupil,accounting for 66.5%,followed by strabismus(12.8%).The median follow-up time was 59.7 months.The enucleation rate was 71.3%(703/986)in a single left eye and 72.5%(702/968)in a single right eye.The overall survival(OS)rate was 95.8%(2444/2552)because 237 patients dropped out,and 109 died.Kaplan‒Meier survival analysis showed that the median survival time(MST)was 125.92 months[95%confidence interval(CI)=124.83–127.01].Cox multivariate survival analysis showed that trilateral RB(P=0.017),metastasis site(P=0.001),and combined distant tissue metastasis(P=0.001)were independent prognostic factors for RB.The OS of 44 cases of familial RB was 93.2%(41/44),with an MST of 80.62 months(95%CI=67.70–93.54).Conclusions The timing of eye protection treatment and enucleation should be comprehensively judged to avoid worsening prognosis due to operation time delay.More importantly,the promotion and popularization of diagnosis and treatment technologies are necessary to further improve RB prognosis.

Fluoxetine is Neuroprotective in Early Brain Injury via its Antiinflammatory and Anti-apoptotic Effects in a Rat Experimental Subarachnoid Hemorrhage Model

Fluoxetine, an anti-depressant drug, has recently been shown to provide neuroprotection in central nervous system injury, but its roles in subarachnoid hemorrhage(SAH) remain unclear. In this study, we aimed to evaluate whether fluoxetine attenuates early brain injury(EBI) after SAH. We demonstrated that intraperitoneal injection of fluoxetine(10 mg/kg per day) significantly attenuated brain edema and blood-brain barrier(BBB) disruption, microglial activation, and neuronal apoptosis in EBI after experimental SAH, as evidenced by the reduction of brain water content and Evans blue dye extravasation, prevention of disruption of the tight junction proteins zonula occludens-1, claudin-5, and occludin, a decrease of cells staining positive for Iba-1, ED-1, and TUNEL and a decline in IL-1 b, IL-6, TNF-a, MDA, 3-nitrotyrosine, and 8-OHDG levels. Moreover, fluoxetine significantly improved the neurological deficits of EBI and long-term sensorimotor behavioral deficits following SAH in a rat model. These results indicated that fluoxetine has a neuroprotective effect after experimental SAH.

Report of seven children with undifferentiated embryonal sarcoma of the liver

Undifferentiated embryonal sarcoma of the liver (UESL) very rarely presents clinically.Approximately 1% to 4% of all solid tumors in children are malignant liver tumors,and UESL accounts for 9% to 15% of the liver tumor.The onset of UESL usually occurs at 6 to 10 years of age and there is no obvious difference based on sex.[1] The first symptoms of UESL are abdominal distention and abdominal pain without jaundice,while a physical examination commonly reveals no positive vital signs except the palpable liver tumor.[1] The serum alphafetoprotein (AFP) test is not sensitive for UESL.[2] Preoperative diagnosis of UESL is very difficult.

Detection of Subclinical Anthracyclines＇ Cardiotoxicity in Children with Solid Tumor

Background： Cardiotoxicity is one of the most serious chronic complications ofanthracyclines therapy. Assessment of the left ventricular ejection fraction （LVEF） fails to detect subtle cardiac dysfunction of left ventricular （LV）. This study aimed to detect and evaluate new parameters of subclinical anthracyclines＇ cardiotoxicity in children with solid tumor. Methods： A detailed echocardiographic examination was performed in 36 children with hepatoblastoma or rhabdomyosarcoma after receiving anthracyclines＇ chemotherapy and 36 healthy controls from January 2015 to December 2016. The LVEF, ratio of early diastolic peak velocity of transmitral flow （E） and septal diastolic e＇ mitral annular peak velocity （e＇）, tricuspid annular plane systolic excursion （TAPSE）, and LV global longitudinal strain （GLS） were evaluated using M-mode, tissue Doppler imaging （TDI）, and two-dimensional speckle tracking echocardiography （2D-STE）, respectively. Echocardiographic parameters were compared between patient group and healthy controls. All patients were divided into two subgroups based on their anthracyclines＇ cumulative dosage （〈300 mg/m^2 subgroup and ≥300 mg/m^2 subgroup）. Results： All patients had no presentation of heart failure and LVEF within normal range （65.7 ± 5.1%）. Compared with healthy controls, the mean E/e＇ increased significantly （7.9 ±0.7 vs. 10.2 ± 3.5, t = 3.72, P 〈 0.01 ）, mean TAPSE decreased significantly （ 17.2 ± 1.3 mm vs. 14.2 ± 3.0 mm, t = -4.03, P 〈 0.01）, and mean LV GLS decreased significantly （-22.2% ± 1.9% vs. -17.9% ± 2.9%, t = -5.58, P 〈 0.01） in patient group. Compared with subgroup with anthracyclines＇ cumulative dosage 〈 300 mg/m^2, mean LV GLS decreased significantly （- 18.7 ＋ 2.7% vs. - 16.5 ~ 2. 1%, t = 2.15, P = 0.04）, the mean E/e＇ increased significantly （9.1 ±1.5 vs. 11.5 ± 4.9, t = -2.17, P = 0.04）, and mean TAPSE decreased significantly （14.2±2.1 mm vs. 12.5±2.2 mm, t = -2.82, P = 0.02） in subgroup with anthracyclines＇ cumulative dosage 〉300 mg/m^2. Conclusions： LV GLS is helpful in the early detection of subclinical LV dysfunction using 2D-STE. E/e＇ and TAPSE are other sensitive parameters in detecting subclinical cardiac dysfunction of both ventricles by TD1. These parameters show significant change with different anthracyclines＇ cumulative dosage, so cumulative dosage should be controlled in clinical treatment.

Perfect prognosis of a boy with alveolar rhabdomyosarcoma of the nasal wing treated with brachytherapy and chemotherapy

To the Editor:Alveolar rhabdomyosarcoma(ARMS)of nasalwingwith distant metastasis has a very poor prognosis.Because it is difficult to achieve complete surgical excision of the primary site of the nasal wing,distant metastasis is not easy to control.Here,we present an unusual case of a 29-month-old boy with ARMS in the left nasal wing accompanied by bone metastasis who was treated with systemic chemotherapy as well as 125I interstitial brachytherapy,and this special multidisciplinary management resulted in a perfect prognosis and mild long-term side effects.